SHM Converge Scientific Abstract ePoster Gallery-Phenobarbital vs. Symptom Triggered Lorazepam for Alcohol Withdrawal on Genmed

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This document summarizes a cohort study comparing a fixed-dose phenobarbital protocol with as-needed benzodiazepines for treating acute alcohol withdrawal on an inpatient general internal medicine service.<br /><br />Alcohol use disorder is common, and about half of affected patients experience withdrawal when they reduce or stop drinking. Benzodiazepines are standard treatment for low- to moderate-risk withdrawal, but evidence is less clear for patients at high risk of severe withdrawal. Phenobarbital is an older alternative that enhances GABA activity and inhibits glutamate, with rapid onset and a long half-life, though concerns about oversedation have limited its use.<br /><br />The hospital introduced a fixed-dose phenobarbital protocol in December 2021 for high-risk patients. Investigators compared outcomes from patients treated with phenobarbital in 2022 to a historical cohort treated with as-needed benzodiazepines in 2018.<br /><br />Overall, the phenobarbital group had higher baseline risk, including more prior complicated withdrawal and higher admission blood alcohol levels and CIWA scores. Despite this, outcomes generally favored phenobarbital: lower rates of death or ICU transfer, delirium, seizures, and excess sedation, though most differences were not statistically significant. Delirium was significantly lower in the phenobarbital group. Length of stay, antipsychotic use, AMA discharge, and 30-day return visits were similar between groups.<br /><br />A sensitivity analysis focused on high-risk patients with prior complicated withdrawal and found similar results, again showing less delirium with phenobarbital and no major safety signal.<br /><br />The authors conclude that fixed-dose phenobarbital appears safe and potentially effective for alcohol withdrawal, especially in high-risk patients, but the study was observational and underpowered. They recommend larger randomized trials to better define when phenobarbital should be preferred over benzodiazepines.

Asset Subtitle

Samuel Hundert

Meta Tag

Author List Jillian McLlarky, Samuel Hundert, William Markle

Category Research

Concept Phenobarbital

Concept Alcohol Withdrawal

Concept Benzodiazepines

Concept Observational Study

Concept Inpatient Treatment

Distinguished Finalist

Presenter Organization Mount Sinai Medical Center

Presenting Author Samuel Hundert

Track Outcomes Research

Keywords

phenobarbital

benzodiazepines

alcohol withdrawal

inpatient study

fixed-dose protocol

delirium

ICU transfer

high-risk patients

CIWA score

observational cohort

Phenobarbital

Alcohol Withdrawal

Benzodiazepines

Observational Study

Inpatient Treatment